冠状动脉造影及冠脉内介入治疗的初步体会

目的　总结 4 1例冠状动脉造影 (CAG)及冠脉内介入治疗 (PCI)的初步体会。方法　回顾性分析4 1例 CAG的造影结果、操作体会及评价 10例 PCI的疗效。结果　 4 1例 CAG均获成功 ,且有 10例冠心病患者接受PCI治疗 ,对 13处病变血管实施经皮腔内冠状动脉成形术 (PTCA) ,共植入支架 16个 ,其中 11个为磷酸胆碱药物涂层支架 (PC支架 ) Biodiv Ysio TMOC,支架置入时最大球囊充盈压力为 12± 2大气压。支架置入后未见残余狭窄 ,总成功率 10 0 % ,术后 3～ 6个月随访未发生再狭窄。结论　 CAG是诊断冠心病的准确方法 ,进一步的 PCI治疗是治疗冠心病的安全有效方法。     

Histological findings after angioplasty using conventional balloon, radiofrequency thermal balloon, and stent for experimental aortic coarctation

Abstract Background : Use of balloon angioplasty or stent implantation has been reported to be effective in relieving coarctation of the aorta. However, restenosis frequently occurs after balloon angioplasty for native aortic coarctation in small infants, and sometimes develops after stent implantation because of vessel growth. The causes of restenosis remain uncertain. The purpose of this study was to assess the histologic differences in vascular responses to angioplasty using conventional balloon, radiofrequency thermal balloon (RFTB), or stent for experimental aortic coarctation. Methods : The authors surgically created an aortic coarctation model using 14 puppies. Angioplasty using conventional balloon, RFTB, or stent was performed 1 month after the initial operation. At the acute or chronic phase after angioplasty, the animals were killed and histologic studies were performed. Results : More vascular injuries were noted in the specimens from animals undergoing conventional angioplasty than in those with RFTB or stent. However, neointimal hyperplasia was seen more often after RFTB or stent because of the proliferation of smooth muscle cells from the tunica media, caused by secretion of growth factors. Apoptosis reached a peak 1?2 weeks after angioplasty, regardless of the type of intervention. Conclusions : The authors conclude that angioplasty with RFTB or stent can provide relatively small injuries in the vessel wall for aortic coarctation, but care must be taken to prevent restenosis caused by intimal hyperplasia, because neointima hyperplasia is more frequent after RFTB or stent.     

冠状动脉内注射美托洛尔在急性心肌梗死直接经皮冠状动脉介入治疗中的初步应用

目的观察冠状动脉内直接注射β受体阻滞剂(美托洛尔)对接受直接经皮冠状动脉腔介入治疗的急性心肌梗死(AMI)患者的安全性及其对近期临床和心血管事件的影响。方法将32例AMI患者随机分为美托洛尔组(17例)和对照组(15例),美托洛尔组分别在第1次球囊扩张前和放置支架前向冠状动脉内注射美托洛尔5 mg,对照组注射等容量的0．9%氯化钠溶液。观察两组心率、血压、心肌酶、左室射血分数的变化,同时观察住院期间及发病后30 d心绞痛、再梗死、心力衰竭,血运重建、死亡的发生情况。结果在两组基线资料可比的情况下,冠状动脉内注射美托洛尔对AMI患者的心率和血压均无影响。在注射美托洛尔过程中未发生房室传导阻滞、严重的心动过缓、心力衰竭及低血压。住院期间美托洛尔组和对照组的左室射血分数分别为53．94±5．76和53．33±5．88,心肌酶肌酸激酶峰值分别为(2354．24±693．66)和(1981．87±412．92)U/L,差异均无显著性(P值均＞0．05)。两组住院期间及术后30 d死亡、再梗死、心绞痛、心力衰竭事件发生率的差异均无显著性(P值均＞0．05)。结论在AMI患者的冠状动脉内直接注射8受体阻滞剂是安全的,但无心肌保护作用。     

99mTc-MIBI门控心肌断层显像在冠状动脉支架术后的临床价值

目的:探讨99mTc-甲氧基异丁基异腈(MIBI)门控心肌断层显像(G-MPI)在冠状动脉支架术后疗效评价、判断再狭窄以及预后评估的临床价值。方法:78例患者,冠状动脉支架术后3～12个月内均行G-MPI,其中31例有术前对照。33例复查冠状动脉造影(CAG)。随访13～24个月。结果:①31例复查G-MPI24例心肌灌注有改善,改善率为77.4%。②31例术后静息G-MPI所测左室射血分数(LVEF)较术前由(42.6±8.6)%上升至(49.7%±6.4)%,P<0.05;舒张末期容积(EDV)和收缩末期容积(ESV)分别由(158.2±55.3)ml、(92.6±44.9)ml明显下降到(133.9±39.9)ml、(71.2±28.7)ml,P均<0.01。③33例复查CAG患者,G-MPI对再狭窄诊断的敏感性、特异性、准确性为82.3%、85.0%、84.8%。④随访心脏事件发生率术后G-MPI灌注改善组(1.9%)与异常组(28.6%)之间有极显著差异(P<0.01)。结论:G-MPI对冠心病血运重建术后疗效评价、判断再狭窄以及预后评估具有重要的临床价值。     

冠状动脉血管成形术后再狭窄的研究现状

经皮冠状动脉腔内成形术是目前冠心痛的重要治疗手段，而术后再狭窄的发生严重影响病人的远期疗效与生活质量。本文介绍了再狭窄的发生机制，并从药物、机械、涂层支架、放射及基因方面对再狭窄的防治研究现状进行了综述分析。     

局部应用c-myc反义寡核苷酸对血管成形术后内膜重塑影响

目的：探讨局部转运c-myc反义寡核苷酸对兔腹主动脉粥样硬化狭窄球囊成形术后内膜增殖和重塑的影响。方法：对日本纯系雄性犬耳白兔采用高胆固醇饮食加血管内皮剥脱建立腹主动脉粥样硬化狭窄模型（狭窄≥50％）。随机分为4组：反义治疗组（Ⅰ组）、正义治疗组（Ⅱ组）、盐水对照组（Ⅲ组）及单纯扩张组（Ⅳ组）。分别对各组狭窄段血管进行球囊扩张并进行血管内局部药物转运，4周后取局部药物转运段血管，进行组织形态学及超微结构观察。结果：Ⅰ组新生内膜与中膜面积比率均〈Ⅱ、Ⅲ和Ⅳ组（P（O．05），血管外膜重塑指数〉Ⅱ、Ⅲ和Ⅳ组（P〈0．05）。Ⅰ组c-myc蛋白阳性细胞百分比明显低于Ⅱ、Ⅲ和Ⅳ组（P〈0．01）。结论：c-myc反义寡核苷酸抑制实验性兔腹主动脉血管成形术后内膜增厚、血管重塑。     

急性心肌梗死患者PTCA术后并发症预防和护理

目的观察急性梗死患者PTCA术后并发症的发生情况及护理重点。方法:对88例急性梗死患者PTCA术后并发症分析,并实施相应护理。结果:88例急性梗死患者PTCA术后,严重心律失常7例,穿刺部位血肿2例,迷走社经反射3例。结论:急性梗死患者PTCA术后并发症发生率较高;术后严密监护及有效护理措施,可以减少和预防并发症发生。